Basic Emergency care chapter 51

anaphylaxis
a life-threatening sensitivity to an antigen

cardiac arrest
same as sudden cardiac arrest(SCA)

convulsion
same as seizure

fainting
sudden loss of consciousness from an inadequate blood supply to the brain

first AID
EMERGENCY CARE GIVEN TO AN ILL OR INJURED PERSON BEFORE MEDICAL HELP ARRIVES

hemorrhage
the excessive loss of blood in a short time

respiratory arrest
breathing stops but heart action continues for several minutes

Respiratory arrest
-if breathing is not restored then cardiac arrest occurs
caused by:
*drowning
*stroke
*choking
*drug over-dose
*electric shock
*smoke inhalation
*suffocation
*heart attack
*coma
*other injuries

seizure
violent and sudden contractions or tremors of muscle groups; convulsion

shock
results when tissues and organs do not get enough blood

sudden cardiac arrest(SCA)
the heart stops suddenly and without warning; cardiac arrest

AED
Automated external defibrillator

AHA
American heart Association

BLS
basic life support

CPR
CARDIOPULMONARY RESUSCITATION

EMS
Emergency Medical Services

RRT
rapid response team

SCA
Sudden cardiac arrest

VF
Ventricular fibrillation

V-fib
Ventricular fibrillation

what are you encouraged to do
to take a first aid course and a basic life support course. these courses prepare you to give emergency care

what are the goals of First aid
-prevent death
-prevent injuries from becoming worse

what is activated during an emergency
THE EMS is activated, the emergency personnel(ex: paramedics,medical technicians) rush to the scene.

what do the EMS people do
they treat
-stabilize
-and transport persons with life threatening problems

what does the ambulances have
-drugs,equipment,and supplies
-guidelines for care
-communication with doctors in emergency rooms
-the doctors tell them what to do

to activate EMS system
-dial 911
-call local fire or police department
-call the phone operator

THE RRTs
-called to bedside when person shows warning signs of life- threatening conditions
-includes doctor,RN, and respiratory therapist,
-their goal is to prevent death

Rules of emergency care
-know your limits. do not do more than your able to
-stay calm. helps person feel secure
-know where emergency supplies are
-check for life threatening problems. check for breathing, pulse and bleeding.
-keep person lying down or as you found him or her. moving person can cause more injury
-move person only if setting is unsafe. Example: burning building or car,building going to collapse,stormy conditions with lighting, in water, or near electrical wires
-wait for help to arrive if scene is not safe enough for you to approach
-do not remove clothes unless needed to. tear or cut clothe along the seams
-keep person warm. cover with sweater or coat
-reassure the person. explain what has happened and help is called
-do not give person food or fluids
-keep onlookers away. they invade privacy, and stare at person and person may think its worse than it is

call for help or have someone activate the EMS system. do not hang up until operator has hung up. give operator the following information:
-your location
-phone your calling from
-what happened
-how many people need help
-conditions of victims, obvious injuries, and life threatening situations

who decides when to activate the EMS system in a nursing center
-THE NURSE. they also tell you how to help
-if person stopped breathing or is in sudden cardiac arrest. the nurse starts CPR
-some centers allow CNAs start CPR
-when death is expected in persons with terminal illnesses. usually these persons are not resuscitated. which you will find in care plan

During emergencies
-contact with blood, body fluids, secretions, and excretions is likely. follow standard precautions and the bloodborne pathogen standard to the extent possible

when emergency occurs in agency
-call the nurse at once
-you may need to activate the EMS system or RRT
-or take persons vital signs
-assist as instructed by the nurse

when the heart and breathing stops
-the person is clinically dead
-blood is not circulated through body
-heart, Brian and other organ damage occurs

the AHA BLS procedure
support circulation and breathing

chain of survival for adults
-the AHA’s BLS courses teach the adult chain of survival
-these actions are taken for, heart attack, sudden cardiac arrest, respiratory arrest, stroke and choking
-they are done as soon as possible
-any delay reduces persons chance of survival

chain of survival actions for adults is
-recognizing cardiac arrest and activating the EMS at once
-early cardiopulmonary resuscitation (CPR)
-Early defibrillation
-Early advanced care. This given by EMS staff, doctor, and nurses. they give drugs and provide life saving measures
-organized post-cardiac arrest care. this is given to improve survival following cardiac arrest

Sudden cardiac arrest
-breathing stops as well
-brain damage can occur unless circulation is restored

3 major signs of SCA
1) no response
2) no breathing or no normal breathing. This person may have agonal(means to struggle and also used for death or dying) ) gasps or agonal respirations early during SCA
*Agonal gasps dont bring enough oxygen into lungs
*Gasps are not normal breathing
3) no pulse. persons skin is cool,pale,or gray. the person is not coughing or moving

SCA
-is a sudden, unexpected and dramtic event
-cause by: heart disease, drowning, electric shock, severe injury, choking and drug over-dose. these causes lead to abnormal heart rhythm called ventricular fibrillation and heart will not pump blood

Rescue Breathing
-given when there is a pulse but no breathing or only gasping.

To give rescue breaths
*open the airway
-give 1 breath every 5 to 6 seconds for adults
-give 1 breath every 3 to 5 seconds for infants or children
-give each breath over 1 second. chest should rise
-check for pulse every 2 minutes. if there is no pulse, begin CPR. if the pulse is lower than 60 in an infant or child begin CPR

CPR for adults
-CPR starts at once when person has SCA
-CPR supports circulation and breathing
-it provides blood and oxygen to organs until advance care is given
-procedures require speed, skill, and efficiency
-you use chest compressions, airway, and breathing until defibrillation arrives and use as soon as possible

CPR for adults involves
-chest compressions
-airway
-breathing
-defibrillation

chest compressions
-force blood through the circulatory system
-before starting chest compressions check for pulse
-use the carotid artery on side near you for pulse
– to find the carotid pulse, place 2 or 3 fingertips on the trachea(windpipe)
-then slide your fingertips down off the trachea to groove of neck
-check for pulse for atleast 5 seconds but no more than 10 seconds
-while checking for pulse look for signs of circulation: see if person started breathing or coughing

THE HEART
-lies between the sternum and spinal column
-when pressure is applied to sternum it becomes depressed, which compresses the heart between sternum and spinal column
-for effect chest compressions , the person must be supine on a hard, flat surface-floor or back-board. you are positioned at the persons side

Hand position during chest compressions
-use heal of hands-one on top of other
-expose persons chest . u need to see persons skin
-place heel of one head(usually the dominate hand) in the center of chest. the heel of this hand is placed on the sternum between nipples
-place heel of your other hand on top of the heel of the first hand

IF injuries are present
special measures are needed

TO give chest compressions
-ur arms are straight, shoulders are directly over your hands, and fingers are interlocked
-exert firm downward pressure to depress adult sternum at least 2 inches
-release pressure without moving your hands from chest, this allows chest to recoil-return to normal position and heart is filled with blood

AHA recommends
-give compressions at a rate of 100 per minute
-push hard and push fast
-push deeply into chest
-interrupt chest compressions only when necessary. interruption should be less then 10 seconds
– when there are no chest compressions blood does not flow

Airway
-respiratory passages must be open to restore breathing
-airway is often obstructed during SCA
persons tongue falls towards back of throat and blocks airway

Head tilt-chin lift method
-opens airway
-place palm of one hand on forehead
-tilt head back by pushing down on forehead with palm
-place fingers of your other hand under lower jaw. use index and middle fingers. do not use your thumb
-lift jaw. this brings the chin forward
-do not close mouth of person. the mouth should be slightly open unless you need to do mouth-to-nose breathing

Breathing
-rescuer inflates the persons lungs
-each breath should take 1 second,chest should rise with each breath
-two breaths are given for every 30 chest compressions
-when two rescuers perform CPR on an infant or child, 2 breaths are given after every 15 compressions

mouth-to-mouth breathing
-is one way to give breaths
-contact with blood, body fluids are likely
-keep airway open with head tilt-chin lift method
-pinch persons nostrils shut.use your thumb and index finger. use hand on forehead. shutting the nostrils prevents air from escaping through the nose
-take a breath. regular breaths are needed not deep breaths
-place mouth tightly over persons mouth
-blow air into persons mouth. you should see the chest rise and also hear air escape when person exhales
-repeat head tilt-chain lift method if persons chest didnt rise
-remove your mouth from persons mouth then take a deep breath

barrier device breathing
-a barrier device is used for giving breaths
-device prevents contact with persons mouth and body fluids
-face shield maybe used and replaced with a face mask as soon as possible
-seal device against persons face
-open airway with the head tilt-chain lift method
-a bag valve mask is another device used:
*consists of hand-held bag attached to a mask and bag is squeezed to give breaths
-the bag can be connected to a oxygen source

MOUTH-to-nose breathing used when
-you cannot breathe through the persons mouth
-you cannot open the mouth
-your mouth is too small to make a tight seal for mouth-to mouth breathing
-the mouth or jaw is severely injured
-the person is bleeding from the mouth

steps to Mouth-to-nose breathing
-mouth is closed
-head tilt-chin lift method is used
-pressure is placed on chin to close the mouth
-to give a breath place mouth over persons nose and blow air into the nose

Mouth-to-stoma breathing
-stomas is a opening in their necks
-keep persons mouth closed
-do not tilt persons head back
-seal your mouth around the stoma
-blow air into the stoma
-if persons chest does not rise you may need to pinch nostrils shut

before giving mouth-to-mouth or mouth-to-nose
make sure to check if person has a stoma or not.

Defibrillation
-ventricular fibrillation is an abnormal heart rhythm
-causes sudden cardiac arrest
-rather then heart beating normal it shakes and quivers like a bowl of jell-o
-heart is not pumping blood
-defibrillator is used to deliver a shock to the heart. The shock stops the VF. which allows regular rhythm to return
-after onset of VF defibrillation is used increases persons chance of survival

for adults the AHA recommends that rescuers
-attach and use the automated external defibrillator as soon as possible
-minimize interruptions in chest compressions before and after shock is is delivered
-give one shock. then resume CPR.begin with compressions. do 5 cycles of 30 compressions and 2 breaths
-check for a heart rhythm

where are AEDs found
-hospitals, nursing centers, dental offices and other heather care agencies
-they are on airplanes and airports,health clubs, malls, and other public places and even in homes

focus on children and older persons Defibrillation
-a key or switch is used to change the dosage. or child pads are used
-follow manufacturers instructions
-the shock dosage for children 8 years and older is the same for adults
-if under 8 years old lower shock dosage is used
-for infants a manual defibrillator is used
-trained staff and EMS use the defibrillator
-pads must not touch or overlap
-if a defibrillator is not available and AED with child dose is used and you can use adult dose if nothing is available

performing adult CPR
-done only for cardiac arrest
-CPR is only done if person does not respond or is not breathing normally and has no pulse
-CPR can be done with 1-2 persons
-when done alone you have to do both rescue breaths and comparisons
-rescuers switch tasks every 2 minutes to avoid fatigue and inadequate compressions
-second rescuer uses the AED if one is available

good communication is needed when 2 rescuers perform CPR
-the rescuer giving compressions must count out load so other person is ready to give breaths
-good communication prevents delays and minimizes interruptions in chest compressions

Promoting safety and comfort
-never practice CPR on another person. damage can occur
-Mannequins are used to learn and practice CPR
-if person is in bed provide a board under person or move them to the floor

Procedure for adult CPR-one rescuer
-make sure scene is safe
-take 5to 10 seconds to check for a response and breathing:
*to check if person is responding tap or gently shake person
*check for no breathing or no normal breathing(gasping)
-call for help. Activate the EMS or RRT if person is not responding
-get or ask someone to get the AED
-position person on hard flat surface supine position. logroll person so there is no twisting of spine. place arms alongside body
-check for carotid pulse. only takes 5-10 seconds. start compressions if you dont feel a pulse
-give chest compressions at a rate of 100 per minute. push hard and fast. press down 2 inches. give 30 chest compressions
-give 2 breaths. each breath should take 1 second
-limit interruptions for less then 10 seconds do CPR until AED arrives
-if person starts to move place the person in recovery position

procedure for Adult CPR with AED-Two rescuers
Rescuer number 2:
-open AED case
-apply electrode pads to chest
-attach cables to AED
-clear away from person. no one can teach the person
-press chock button if person advices the shock
-perform CPR again after shock.
-do 2 minutes of CPR. 5 cycles of 30 compressions and 2 breaths
-begin with chest compressions when doing CPR

Hands-only CPR
-when someone has cardiac arrest. the survival depends on others nearby
-AHA developed the hands-only CPR to improve the response of bystanders
two steps for hands-only CPR:
*call 911
*push hard and fast in the center of the chest
-this is used to educate persons not trained in BLS
-if your a health care provider use CPR method and BLS courses

Recovery position
-this position is used when person is breathing
-they have a pulse but is not responding
-this position keeps airway open and prevents aspiration
-logroll the person into recovery position. keep head, neck, spine straight and hands support head
-do not use this position if person has neck injuries or trauma

AHA defines child and an infant as followes:
-child-from 1 year of age to puberty. puberty is marked by secondary sex characteristics in males and females
-infant-from birth(outside of delivery room) until 1 year of age

chain of survival for children
-sudden infant death syndrome(SIDS) is the sudden unexplained death of a infant younger than 1 years of age
-leading cause of death for 1 month and 1 year of age
-most SID death occur in babies between 2 month and 4 month and occurs during sleep
-cardiac arrest is rare in children
-common cause in children is respiratory diseases or injuries that lead to circulatory failure

major death producing injuries
-guns
-smoke inhalation
-drowning
-burns
-motor vehicles crashes

AHA’s pediatric chain of survival involves these steps
-preventing cardiac arrest
-early and effective CPR
-Rapid activation of the EMS system or the Agency’s RRT
-early and effective advanced life support
-organized post-cardiac arrest care

CPR rules for children
-perform 5 cycles of CPR. Than activate the EMS or the RRT
-activate the EMS first if the arrest was sudden and witnessed . then begin CPR
-count pulse for at-least 5 seconds but no more then 10
-start CPR if child’s heart rate is less than 60 beats per minute with signs of poor circulation
-use same hand position u used for adults
-use two hands for chest compressions but if chest is small use one hand
-give chest compressions at least 1/3 depth of chest about 2 inches
-allow chest to recoil after each each compression
-rate of 100 per a minute push hard and fast
-1 rescuer-30 compressions followed by 2 breaths
-2 rescuers – 15 compressions followed by 2 breaths
-use child pads and child system if children are younger then 8

for the heart rate per minute in children:
-5 seconds: multiply by 12
-10 seconds : multiply by 6

infants CPR
If your alone:
-perform 5 cycles of CPR then activate the EMS
-use the brachial artery to check for pulse
*place the index and middle finger on the inside of the infants upper arm. between the elbow and shoulder
-press gently for 5-10 seconds

locating hand position for chest compressions in infants
-draw a imaginary line between the nipples. find the sternum
-place 2 fingers on the sternum just below the imaginary line

giving chest compressions to infants
-press lower half of sternum. do not press on the bottom of the sternum
-use enough pressure to press down at least 1/3 the depth of the chest (about 1 1/2) inches

use the 2 thumb-encircling hands method for chest compressions when there are 2 rescuers
-draw imaginary line between nipple. find the sternum(breastbone)
-place both thumbs just below the imaginary line
-thumbs are side by side in the center of the chest(thumbs may overlap.The infant may be small. or you may have large hands
-encircle the infants chest with your hands
-support the infants back with your fingers. use both hands
-press down on the sternum with your thumbs. squeeze the chest with fingers. press down atleast 1/3 in depth of chest or 1 1/2 inches
– release pressure and allow chest to recoil after each compression

give compressions at a rate of 100 per a minute
1 rescuer-30 compressions followed by 2 breaths
2 rescuers- 15 compressions followed by 2 breaths

use head tilt-chin lift method to open airway so becuz tongue obstructs airway when it falls on throat
-place one hand on infants forehead
-use palm to push head back
-place fingers of your other hand under bony part of lower jaw. this near the chin. do not press in deep
-use fingers not thumb to lift jaw to bring the chin forward. the head should be in a neutral (sniffing) position
-do not close infants mouth completely

use the mouth-to-mouth-and-nose method to give breaths on infants
-preferred method
-use mouth-to-mouth method if you cannot cover the infants nose and mouth
-to give mouth-to-mouth-and-nose breaths:
*keep airway open with head tilt-chin lift method
*cover the infants nose and mouth with your mouth. make sure its tight
-give two breaths to make chest rise if it doesn’t try again and continue until AED is available. use child pads.

Child CPR- one rescuer
-take 5-10 seconds to check for pulse
-call for help if child is not responding
-before doing CPR if arrest was sudden and witnessed activate the EMS or get an AED
–position child in a supine hard flat surface. and logroll child
-check for carotid pulse. takes 5-10 seconds
-if there is no pulse or its under 60 with signs of poor circulation:
*expose child’s chest. and give chest compressions at a rate of at least 100 per minute. push hard and fast.
-count out loud
-press down at least 1/3 depth of chest( about 2 inches)
-give 30 compressions
-then open airway useing head tilt-chin lift method and give 2 breaths. and should take about 1 second
-after 5 cycles (2 minutes) of CPR activate EMS
-give shock then do CPR again
-start with chest compressions. if rhythm is not shockable start CPR
-check rhythm after 5 cycles of CPR

child CPR with AED-two rescuers
-recuer turns on AED
-apply child electrode pads if available or use switch to change to child setting. use adult pads if neither is available
-the pads must not overlap or touch
-clear away from child
-after shock perform two rescuer CPR
-begin with compressions. one rescuer gives chest compressions at rate of 100 per minute. push hard and fast
-allow chest to recoil between compressions
-give 15 compressions. then other person gives 2
-after 2 minutes of CPR(10 cycles of 15 compressions) do shock again

infant CPR- one rescuer/two rescuer
-place 2 fingers on the sternum just below the nipple line
-press down at least 1/3 depth of chest( about 1 1/2) allow chest to recoil between compressions. give 30 chest compressions if your by your self then 2 breaths
-check rhythm after 5 cycles of CPR
-if your with some else you do 15 compressions and 2 breaths
-do shock again after 2 minutes ( 10 cycles of 15 compressions)

Choking
-foreign bodies can obstruct the airway. also know as choking or FBAO
-air cannot not pass to lungs
-body doesn’t get enough oxygen which leads to cardiac arrest
-severe obstruction causes air to not go in or out of lungs and person can die
-abdominal thrust is given to relieve severe airway obstruction

hemorrhage info
-life and body functions require an adequate blood supply
-the larger the blood vessel the greater the bleeding
-person can die if bleeding continues
-there is internal and external bleeding

internal bleeding
-the bleeding is inside body cavities and tissue
-pain, shock, vomiting blood, coughing blood and loss of consciousness signal internal bleeding
-you have to activate the EMS
-keep person warm,flat,and quit until help comes
-do not give fluids

external bleeding
-it is seen
-bleeding from artery occurs in spurts
-steady flow of blood from vein
-to control it:
*activate the EMS
*do not remove any stabbed or piercing person
*elevate the affected area
*place a sterile dressing over wound
*apply pressure with your hand. do not release pressure till bleeding stops
-if direct pressure does not control bleeding. apply pressure over artery above the bleeding site. for example if bleeding is from the lower arm, apply pressure over the brachial artery.
-bind the wound when bleeding stops. you can tie the dressing in place.

Fainting
-hunger, fatigue, fear and pain, blood,standing in one position for too long,being in warm crowded room are common causes
-dizziness, perspiration(sweating) , and blackness before the eye are warning signals
-person looks pale and pulse is weak
-respirations are shallow if consciousness is los

emergency care for people who are fainting
-have the person sit or lie down before fainting occurs
-if sitting person bends down and places head between knees
-if person is lying down rise the legs
-loosen tight clothing
-keep person lying down if fainting occurred. raise legs
-do not let person get up for 5 minutes
-help person to a sitting position after recovery

Shock causes
-blood loss
-heart attack(myocardial infraction)
-burns
-severe infection

signs and symptoms of shock
-low or falling blood pressure
-rapid and weak pulse
-rapid respirations
-cold, moist, pale skin
-thrist
-restlessness
-confusion and loss of consciousness

shock rules
-can happen to any person
-keep person lying down
-maintain an open airway
-control bleeding
-begin CPR if cardiac arrest occurs

Anaphylactic shock
-many people are allergic to penicillin
-an antigen is a substance that the body reacts to
-person may react with a area of redness, swelling, or itching
-its a emergency
-keep person lying down and airway open
-start CPR if cardiac arrest occurs

sign and symptoms of anaphylaxis
-sweating
-shortness of breath
-low blood pressure
-irregular pulse
-respiratory congestion
-swelling of the larynx( laryngeal edema)
-hoarseness
-dyspnea

Stroke
-know as a cerebrovascular accident
-brain deprived of blood supply
-only part of the brain is effected
-caused by thrombus, embolus or hemorrhage if blood vessel in brain ruptures
-signs depend on size and location of brain injury
-loss of consciousness or semi conciseness, rapid pulse, labored respirations, high blood pressure, facial drooping, and hemiplegia( paralysis on one side of body) are signs of stroke
-person may also have confusion, numbness, slurred speech, and aphasia, loss of vision , headache, unsteadiness, falling and seizures can occur

emergency care for stroke
-activate the EMS
-find out when symptoms begin
-position person in recovery position
-raise the head without flexing neck
-loosen tight clothing
-keep person quit and warm
-reassure person
–provide CPR
-provide care for seizures if needed

Seizures
-movements are uncontrolled
-person loses consciousness
-caused by abnormality in brain
-causes include: head injury during birth or before trauma
-high fever
-brain tumors
-poising
-nervous system disorders
-lack of blood flow seizure disorders
-epilepsy is also a cause of seizure

Epilepsy
-cluster of nerve cells sometimes signal abnormally
-brief changes in brains electrical function
-person has strange sensations, emotions, and behavior
-there is seizures, muscle spasms, and loss of consciousness
-single seizure doesn’t mean epilepsy. in epilepsy seizures occur
-person has a permanent brain injury or defect

Epilepsy causes
-brain injury before, durning, or after birth
-problems with brain development
-mother having a injury or infection before birth
-head injury
-poor nutrition
-brain tumor
-childhood fevers
-poison
-infection
-stroke
there is no cure but doctors give drugs
-does not effect learning and daily activities if controlled

partial seizure
A seizure that affects only one part or one side of the brain.
-body part may jerk
-person may get hearing or vision problems
-stomach discomfort
person does not lose consciousness

generalized tonic-clonic seizure (grand mal seizure)
two phases:
1) in the tonic phase person loses consciousness. if standing or sitting person falls and body is rigid and muscle contracts at once
2) clonic phase muscle groups contract and relax. causes jerking and twitching movements and urinary and fecal incontinence occur
-deep sleep is common after seizure and confusion and headache occur after waking up

generalized absence ( petit mal seizure)
-lasts a few seconds
-loss of consciousness
-twitching of the eyelids and staring occurs
-guide person away from danger but no first aid is needed

Emergency care for seizures
-activate EMS
-do not leave person alone
-lower person on floor
-note the time seizure started and ended
-place something soft under persons head. prevents person head from striking the floor
-loosen jewelry and clothing
-turn person onto his or her side
-do not put objects or fingers between persons teeth
-do not try to stop seizures or control persons movement
-move furniture equipment and sharp objects
-make sure mouth is clear of food and fluids and saliva
-provide BLS if person is not breathing after

Burns
-infants children and older person are at risk
-occur at home

burns and fires are
-scalds from hot liquids
-playing with matches and lighters
-electrical injuries
-cooking accidents
-falling asleep while smoking
-fireplace
-space heaters
-no smoke detectors or non-functioning smoke detectors
-sunburn
-chemicals

superficial (first degree burns)
-involve the epidermis only
-they are painful but burns are not severe

partial thickness(second degree) burns
-involve the epidermis and part of dermis
-very painful
-nerve ending are exposed

full thickness ( third degree) burns
involve the entire epidermis and dermis
-fat, muscle, and bone may be injured or destroyed
-they are not painful
-nerve endings are destroyed

which burns are more serious then burns to the arm or leg
-face
-eyes
-ears
-hands
-feet

severity of a burn depends on burns
-size and depth
-persons age
-body part involved

emergency care for severe burns
-activate the EMS
-do not touch person if he or she is in contact with an electrical source
-remove person from fire or burn sources
-stop the burning process
-do not remove burned cloths
-remove hot clothing that is not sticking to the skin
-remove jewelry that is not sticking to the skin
-provide CPR if needed
-cover burns with sterile cool and moist coverings
-do not put oil, butter, salve or ointments on the burns
-cover person with a blanket or coat to prevent heat loss

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